Femoral intramedullary rod system

ABSTRACT

A femoral intramedullary rod system capable of treating a variety of femoral bone fractures using a uniform intramedullary rod design. The system generally comprising an intramedullary rod defining an opening having an upper surface and a transverse member including a bone engaging portion and a connection portion defining a thru-hole with the nail sized to pass therethrough. A pin is selectively coupled to the transverse member to rigidly assemble the transverse member to the nail when the nail is passed through the thru-hole and the pin is received within the opening. In an alternative design, an epiphyseal stabilizer is joined to the nail by a locking member.

The present application is a continuation-in-part of U.S. patent application Ser. No. 09/619,189 filed Jul. 19, 2000 now U.S. Pat. No. 6,402,753 and claims the priority thereof, which is a divisional of U.S. patent application Ser. No. 09/329,688 filed Jun. 10, 1999, now U.S. Pat. No. 6,221,074, each of the above are hereby incorporated by reference.

FIELD OF THE INVENTION

The present invention is directed to techniques for treating bone fractures. Specifically, but not exclusively, the invention relates to a system for treating a variety of typical femoral fractures using a uniform intramedullary rod design.

BACKGROUND OF THE INVENTION

The femur generally comprises an elongated shaft extending from the hip to the knee. The proximal end of the femoral shaft includes a neck segment connected to a head portion. The head portion fits into a concavity of the hip bone to form a ball and socket joint at the hip. The distal end of the femoral shaft engages the upper end of the tibia to form the knee joint. Overall, the femur is one of the longest and strongest bones in the human body; however, portions of the femur are extremely susceptible to fracture.

Internal fixation of femoral fractures is one of the most common orthopedic surgical procedures. Many different types of femoral fractures are encountered in practice, including fractures of the femoral neck, midshaft, and distal regions. When the femur is fractured, treatment requires that the fractured bone be substantially immobilized and held together in an abutting relationship during the healing process. Any longitudinal, transverse, or rotational movement of one section of the fractured bone relative to the other can cause substantial delay in healing time or cause improper healing to occur. In general, two different internal fixation approaches have been used to immobilize the area surrounding the fracture site.

One approach involves driving metallic pins through the two sections of bone to be joined and connecting them to one or more plates bearing against the external surface of the bones. However, such an arrangement injures the flesh and muscle surrounding the bones and a large number of pins driven through the bone tend to weaken its hard outer layer. Plates also tend to stress the bone and are not always able to bear sufficient stress for many femoral fracture applications.

Further, bone beneath the plate does not always become as strong as it would in the absence of the plate. A second approach to treating femoral fractures involves the use of an intramedullary nail which is inserted into the medullary canal of the femur and affixed therein by a number of different methods. After complete healing of the bone at the fracture site, the nail may be removed through a hole drilled in the proximal end of the femur. A wide variety of devices have been developed over the years for use in the internal fixation of femoral fractures utilizing the method of intramedullar stabilization and immobilization. While there have been a number of technological advances made within the area of intramedullary fixation of femoral fractures, several problem areas remain.

One such problem arises from the fact that most intramedullary fixation systems currently available are adapted to a specific type of femoral fracture, resulting in a large number of highly specialized configurations. This has led to the disadvantageous consequence that hospitals and trauma centers have to keep a large inventory of incremental nail lengths with varying configurations and ancillary parts in order to accommodate a random and diverse incoming patient population. Maintaining such a high level of inventory to handle all expected contingencies is not only complex, but is also very expensive. Correspondingly, the possibility of error during selection and implantation of the fixation device by the surgeon is elevated. Likewise, the inventory costs associated with varying methods of intramedullary fixation are drastically increased and, in the case of smaller medical facilities, may necessitate switching to a less costly and potentially less effective method of treating femoral fractures.

Another problem may result from intramedullary rod systems used to specifically treat fractures of the neck or head of the femur. These devices typically include a transverse fixation member (nail, pin, screw, etc.) adapted to be positioned along the longitudinal axis of the femoral neck with its leading end portion embedded in the femoral head so as to grip the femoral head and thereby stabilize the fracture site. The fixation member is operably connected to the intramedullary rod to maintain a fixed relationship between the fixation member and the rod. Unfortunately, this structural connection does not always prevent rotational or translational movement of the fixation member relative to the intramedullary rod in response to forces commonly resulting from the normal activity of a convalescing patient. Additionally, the intramedullary rods used in these devices are typically specialized for use with this single fixation application and can not be used in other applications. Therefore, the costs associated with maintaining increased levels of inventory are substantially increased. Furthermore, if it is desired to vary the angle of the fixation member relative to the rod, substantial modifications must typically be made to either the fixation member or the rod member to accommodate for such an angular variation, again driving up inventory levels and associated inventory costs.

In still another problem area, on occasion, it is necessary to use transverse locking bone screws to lock the rod into position relative to the femur. In order to prevent the screws from backing out, locking nuts can be threaded onto the distal ends of the locking screws. Unfortunately, the installation of locking nuts onto the ends of the locking screws requires additional surgical incisions and commonly causes soft tissue irritation.

In yet another problem area, when an intramedullary rod is inserted into the medullary canal and anchored to the femur by two or more bone screws, despite the best efforts of the surgeon, the fracture site may have either been over-compressed or over-distracted as a result of the insertion of the rod. Unfortunately, with conventional intramedullary rods, it is virtually impossible to adjust the amount of distraction or compression without first removing one or more of the bone screws and manually distracting or compressing the fracture site. The intramedullary rod must then be re-anchored to the femur by reinserting the bone screws at different positions along the femur.

Thus, there is a demand for bone treatment techniques to address these problems. The present invention meets this demand and provides other benefits and advantages in a novel and unobvious manner.

SUMMARY OF THE INVENTION

The present invention is directed to techniques for treating bone fractures. Various aspects of the invention are novel, nonobvious and provide various advantages. While the actual nature of the invention covered herein can only be determined with reference to the claims appended hereto, selected forms and features of the preferred embodiment as disclosed herein, are described briefly as follows.

One form of the present invention includes treating a bone fracture with a nail that defines an opening and a transverse member including a bone engaging portion and a connection portion. The connection portion defines a through-hole and the nail is sized to pass through the through-hole. A pin is adjustably coupled to the transverse member to rigidly assemble the transverse member to the nail.

In a further form of the present invention, a method of treating a bone fracture includes forming a first hole in a femur transverse to the medullary canal and introducing a transverse member through the first hole. The transverse member includes a through-hole that is positioned relative to the medullary canal of the femur, and is preferably aligned therewith. The method further includes forming a second hole intersecting the medullary canal and inserting an intramedullary nail into the medullary canal via the second hole. The nail passes through the through-hole of the transverse member. The nail may include an opening aligned with the transverse member to facilitate rigid assembly to the transverse member by positioning a pin coupled to the transverse member in the nail opening.

In still another form of the present invention, a system for treating bone fractures includes a nail having a first end portion opposite a second end portion along a longitudinal axis. The first end portion defines an opening extending through the nail and has an angled surface oriented at an oblique angle relative to the longitudinal axis of the nail. Also included is a sleeve that includes a pair of apertures positioned on opposite sides of the sleeve. The apertures and the opening align to form a passageway when the sleeve is fitted over an end portion. A bone engaging member is received within the passageway in an abutting relationship with the angled surface.

In yet another form of the present invention, a bone fracture treatment apparatus includes an elongated nail having a longitudinal axis and a transverse axis generally perpendicular to the longitudinal axis. The nail defines a transverse opening extending along the transverse axis with the opening being bound by an upper surface and an opposite lower surface. At least one of the upper or lower surface defines a projection extending in a longitudinal direction to thereby narrow a dimension of the opening within the nail. The nail opening, and projection may be arranged to cooperate with one or more other members suitable to treat a particular type of bone fracture, such as a fracture of the femur.

According to another form of the present invention, a system for treating bone fractures includes a nail defining a longitudinal axis, a transverse axis and an opening extending along the transverse axis with the opening being bound by a bearing surface. Also included is a sleeve having a pair of apertures positioned on opposite sides thereof. The apertures and the opening are aligned to form a passageway when the sleeve is fitted over the nail. A bone engaging member is sized to pass through the passageway. Additionally, the system may include a means for biasing the sleeve in a longitudinal direction to clamp the bone engaging member against the bearing surface.

Still a further form of the present invention includes a technique for treating bone fractures with a nail that defines a longitudinal axis, an elongated opening extending therethrough, and a longitudinal passage intersecting the opening. A bone engaging member passes through the opening and a positioning device is provided that may be adjusted to change position of the bone engaging member along the longitudinal axis relative to the nail when the member is positioned through the nail opening. This device may be utilized to facilitate compression or distraction of a bone fracture.

In yet another embodiment of the present invention, an epiphyseal stabilizer is provided in conjunction with an intermedullary nail. In a preferred aspect, the stabilizer includes a longitudinally extending recess. Preferably, the recess is adapted to slidingly receive at least a portion of the intermedullary nail. It is contemplated that a locking member can be disposed between the stabilizer and nail to maintain their relative position.

Still a further aspect of the present invention is an eccentric reaming head. Preferably, the reaming head includes a cutting surface positioned along the longitudinal axis and a substantial portion of the head body opposite the cutting surface is non-cutting. In a preferred aspect the non-cutting surface is substantially cylindrical and is configured to guide the cutting operation away from adjacent surfaces.

Accordingly, one object of the present invention is to provide an improved bone fracture treatment system. Preferably, this system may be used to treat fractures of the femur.

Additionally or alternatively, another object is to provide an improved method of treating bone fractures, particularly fractures of elongated bones such as the femur.

Additionally or alternatively, still another object is to reduce the complexity and inventory costs associated with treating bone fractures.

Other objects, features, forms, embodiments, aspects, advantages and benefits of the present invention will become apparent to persons of ordinary skill in the art from the following written description and accompanying figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view, partly in section, of a rod system of the present invention with a transverse member shown in an antegrade position.

FIG. 2 is a side view, partly in section, of the system of FIG. 1 with the transverse member in a retrograde position.

FIG. 3 is a partial side view of the proximal end portion of the rod of FIGS. 1 and 2.

FIG. 4 is a partial side view of the sleeve of FIGS. 1 and 2.

FIG. 5 is a partial, sectional side view of the proximal end portion of the rod shown in FIG. 3 and the sleeve of FIG. 4 assembled together with the locking member of FIGS. 1 and 2.

FIG. 6 is a side view, partly in section, of another rod system of the present invention implanted in the neck and head of a femur.

FIG. 7 is a partial, sectional side view of the proximal end portion of the system of FIG. 6.

FIG. 8A is a side view of the fixed angle pin of FIG. 7.

FIG. 8B is an end view of the fixed angle pin of FIG. 7.

FIG. 9 is a partial, sectional side view of the proximal end of yet another system of the present invention having a variable angle pin positioned at 135 degrees relative to a rod.

FIG. 10A is a side view of the leading portion of the variable angle pin of FIG. 9.

FIG. 10B is an end view of the leading portion of the variable angle pin of FIG. 9 taken along view line 10B—10B of FIG. 10A.

FIG. 11A is a side view of the trailing portion of the variable angle pin of FIG. 9.

FIG. 11B is an end view of the trailing portion of the variable angle pin of FIG. 9 taken along view line 11B—11B of FIG. 11A.

FIG. 12 is a partial, sectional side view of the proximal end of the system of FIG. 9 showing the variable angle pin at 140 degrees relative to the rod.

FIG. 13 is a side view, partly in section, of still another rod system of the present invention illustrating implantation of an intramedullary nail inserted in a retrograde direction.

FIG. 14 is a partial, sectional side view of the proximal end portion of a further system of the present invention.

FIG. 15 is a side view, partly in section, of another rod system of the present invention for performing distraction of a bone fracture.

FIG. 16 is a partial, sectional side view of the proximal end portion of the rod of FIG. 15.

FIG. 17 is a partial, sectional side view of the proximal end portion of the system of FIG. 15, illustrating a first operational position.

FIG. 18 is a partial, sectional side view of the proximal end portion of the system of FIG. 15, illustrating a second operational position.

FIG. 19 is a side view, partly in section, of an additional intramedullary rod system of the present invention for performing compression of a bone fracture.

FIG. 20 is a partial, sectional side view of the proximal end portion of the system of FIG. 19, illustrating a first operational position.

FIG. 21 is a partial, sectional side view of the proximal end portion of the system of FIG. 19, illustrating a second operational position.

FIG. 22 is a partial, sectional perspective view of an epiphyseal stabilizer and intermedullary nail according to another aspect of the present invention.

FIG. 23 is a diagrammatic view of the apparatus of FIG. 22 positioned in a femur.

FIG. 24 is a diagrammatic view of the apparatus of FIG. 22 positioned in a femur.

FIG. 25A is a top view of an alternative epiphyseal stabilizer according to the present invention.

FIG. 25B is an end view of the apparatus of FIG. 25A.

FIG. 25C is an opposite end view of the apparatus of FIG. 25A.

FIG. 26A is a top view of a reaming head according to the present invention.

FIG. 26B is a side view of the apparatus of FIG. 26A.

FIG. 26C is an end view of the apparatus of FIG. 26A.

FIG. 26D is an opposite end view of the apparatus of FIG. 26A.

FIG. 27 is a cross-sectional view of a bone showing a bone opening.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, any alterations and further modifications in the illustrated embodiments, and any further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.

FIGS. 1–2 depict intramedullary system 10 according to one embodiment of the present invention. System 10 is shown implanted in femur 12 and includes an elongated intramedullary rod or nail 14, sleeve 16 and bone engaging member 18. System 10 also includes fasteners 20 and locking bone screws 22 a, 22 b. FIG. 1 illustrates system 10 as used in a first locking configuration with bone engaging member 18 placed in an antegrade direction within femur 12. FIG. 2 illustrates a second locking configuration of system 10; where bone engaging member 18 is placed in a retrograde position within femur 12. The tip of the greater trochanter 12 a, the neck 12 b, and the head 12 c of femur 12 are designated in FIGS. 1 and 2. Although system 10 is shown implanted in a human femur 12, system 10 could also be used in conjunction with other bones as would occur to one skilled in the art, including, but not limited to, the tibia, humerus, radius, ulna and fibula.

Nail 14 includes a proximal end portion 14 a and a distal end portion 14 b. Nail 14 also defines a longitudinal centerline axis L₁ running along the length of nail 14 between proximal end portion 14 a and distal end portion 14 b. For application to an adult human femur, proximal end portion 14 a preferably has a diameter of about 11–13 millimeters. The diameter of the remainder of nail 14 may vary depending upon the requirements of the fixation procedure and the surgeon's preference. While nail 14 has a generally circular cross section, other suitable shapes are also contemplated as would occur to one skilled in the art.

Referring additionally to FIGS. 3–5, portion 14 b of nail 14 defines generally parallel transverse bores 24 a, 24 b, each sized to respectively receive locking bone screws 22 a, 22 b therein. Distal end portion 14 b also defines transverse bore 24 c, aligned generally perpendicular to transverse bores 24 a, 24 b and sized to receive locking bone screw 22 c (not shown). Proximal end portion 14 a defines an opening 26 and a threaded transverse bore 28, both extending through nail 14 generally transverse to axis L₁ from a first side 14 c to a second side 14 d. Side 14 c generally opposes side 14 d. Proximal end portion 14 a also defines threaded longitudinal bore 29 generally extending along axis L₁ for receiving nail insertion and extraction instrumentation (not shown) used to guide nail 14 into and out of femur 12. Nail 14 also defines a longitudinal passage 30 intersecting bore 29 and extending generally along axis L₁ to allow for the optional use of a guide wire (not shown) to aid in the insertion of nail 14 into femur 12.

Referring more specifically to FIGS. 3 and 5, opening 26 is bound by lower surface 31 opposite upper surface 32. Lower surface 31 includes a first angled surface 31 a oriented generally parallel to transverse axis T₁. Upper surface 32 includes a second angled surface 32 a offset from first angled surface 31 a along axis T₁. Angled surfaces 31 a, 32 a are generally parallel to transverse axis T₁. Transverse axis T₁ is aligned at an oblique angle α₁ relative to longitudinal axis L₁ of nail 14. Angle α₁ is preferably in a range of about 120–150 degrees, with the more preferred angle being about 135 degrees. First angled surface 31 a and second angled surface 32 a cooperate to define pathway 33 generally oriented at angle α₁ relative to axis L₁. First pathway 33 is sized to receive bone engaging member 18 therethrough.

Lower surface 31 also includes a third angled surface 31 b aligned generally parallel to transverse axis T₂. Upper surface 32 also includes a fourth angled surface 32 b generally offset from third angled surface 31 b along axis T₂ that is also generally parallel to transverse axis T₂. Comparing to FIG. 2, transverse axis T₂ is also aligned at an oblique angle α₂ relative to longitudinal axis L₁ of nail 14. Angle α₂ is preferably in a range of about 120–150 degrees, with the more preferred angle being about 135 degrees. Third angled surface 31 b and fourth angled surface 32 b cooperate to define pathway 34 generally oriented at angle α₂ relative to axis L₁. Second pathway 34 is sized to receive bone engaging member 18 therethrough.

First angled surface 31 a and third angled surface 31 b cooperate to define a first projection 35 extending in a longitudinal direction which narrows a dimension of opening 26 within nail 14 along axis L₁. Similarly, second angled surface 32 a and fourth angled surface 32 b cooperate to define a second projection 36 extending in a longitudinal direction generally opposite first projection 35 to further narrow a dimension of opening 26 within nail 14 along axis L₁. In a preferred embodiment, each projection 35, 36 defines an apex, resulting in a convergent-divergent throat 36 a about midway between sides 14 c and 14 d of nail 14. However, first projection 35 and second projection 36 could alternatively define any other geometric configuration as would occur to those skilled in the art. For example, first projection 35 and second projection 36 could be rounded. Likewise, in other alternative embodiments, one or more of projections 35, 36 may be absent. While angled surfaces 31 a, 31 b, 32 a, 32 b are generally concave to compliment member 18, other shapes are also contemplated as would occur to those skilled in the art. For example, angled surfaces 31 a, 31 b, 32 a, 32 b could be flat or have other configurations corresponding to the outer surface of bone engaging member 18.

Referring to FIG. 4, sleeve 16 of system 10 is illustrated therein. Sleeve 16 has a generally cylindrical shape and defines a proximal end 16 a, a distal end 16 b and a side wall 37. Sleeve 16 is sized to fit over the proximal end of nail 14 as shown in FIG. 3. Distal end 16 b is therefore open to allow for passage of proximal end portion 14 a therethrough. Sleeve 16 also defines an inwardly tapered edge 38, terminating at distal end 16 b, to permit easy sliding of sleeve 16 through bone. Proximal end 16 a defines an opening 39 to permit access to threaded bore 29, and thus allow for passage of nail insertion and extraction instrumentation (not shown). Side wall 37 defines offset apertures 40 a, 40 b positioned on opposite sides of sleeve 16. Apertures 40 a, 40 b are generally circular and are aligned and sized to receive bone engaging member 18 therethrough. Side wall 37 further defines opposing transverse apertures 42 a, 42 b positioned on opposite sides of sleeve 16. Apertures 42 a, 42 b are generally circular and are aligned and sized to receive fastener 20 therethrough.

Referring to FIG. 5, therein is illustrated bone engaging member 18. Bone engaging member 18 includes a proximal end portion 18 a and a distal end portion 18 b. Bone engaging member 18 has a generally circular cross section and preferably has a diameter of about 5.5–6.5 millimeters for applications treating fractured adult human femurs. Distal end portion 18 b includes a means for fixedly engaging and gripping bone 44. Bone engaging member 18 may be a bone screw having a threaded distal end portion 18 b as shown in FIG. 5, or a bone blade having distal end portion 18 b formed from a plate with a helical twist (not shown). Alternately, distal end portion 18 b may be otherwise configured for engaging bone as would occur to those skilled in the art.

As illustrated in FIG. 5, when sleeve 16 is fitted over proximal end portion 14 a of nail 14, apertures 40 a, 40 b of sleeve 16 are positioned to align with opening 26 of nail 14, and register with pathway 33 along transverse axis T₁. Collectively, apertures 40 a, 40 b and opening 26 define passageway 50 coincident with pathway 33. Passageway 50 is bound on one side by first angled surface 31 a and on another side by second angled surface 32 a. As bone engaging member 18 is slidably received within passageway 50 and guided along transverse axis T₁, bone engaging member 18 forms an abutting relationship with either or both of first and second angled surface 31 a, 32 a. This relationship may be load bearing in nature. Bone engaging member 18 is sized relative to passageway 50 so that its rotational position about axis L₁ and its translational position along axis L₁ are generally fixed when positioned therethrough.

As illustrated in FIG. 5, when sleeve 16 is fitted over proximal end portion 14 a of nail 14, apertures 42 a, 42 b of sleeve 16 are aligned with bore 28 of nail 14. A fastener 20 is passed through aperture 42 a and threaded into bore 28 to thereby releasably secure sleeve 16 to nail 14. Another fastener 20 is passed through aperture 42 b and threaded into bore 28 to further secure sleeve 16 to nail 14. While two fasteners 20 are shown to releasably secure sleeve 16 to nail 14, it is also contemplated that a single fastener may be used to sufficiently secure sleeve 16 to nail 14. To avoid interfering with the optional use of a guide wire (not shown) to aid in the insertion of nail 14 into femur 12, fastener 20 has a length which penetrates bore 28 far enough to secure sleeve 16 to nail 14, but without obstructing longitudinal passage 30. In still other embodiments, one or more of fasteners 20, bore 28, and apertures 42 a, 42 b may not be utilized at all.

Notably, by rotating sleeve 16 180 degrees relative to nail 14, system 10 may be reconfigured from an antegrade orientation of bone engaging member 18 to a retrograde orientation, or vice-versa. Similarly, regardless of which locking configuration is used, the same components of system 10 can be used to treat either a left or right femur by simply rotating sleeve 16 180 degrees relative to nail 14. As a result, apertures 40 a, 40 b of sleeve 16 are repositioned to align with pathway 34 through opening 26 of nail 14 along transverse axis T₂. Collectively, apertures 40 a, 40 b and opening 26 define passageway 52 which is coincident with pathway 34. Passageway 52 is bound on one side by third angled surface 31 b and on another side by fourth angled surface 32 b (see FIGS. 2 and 5). As bone engaging member 18 is slidably received within passageway 52 and guided along transverse axis T₂, bone engaging member 18 forms an abutting relationship with either or both of the third and fourth angled surfaces 31 b, 32 b. Preferably, this relationship is suitable for load bearing, and generally fixes member 18 with respect to rotation about axis L₁ or translation along axis L₁.

In other embodiments of system 10, the angular alignment of bone engaging member 18 relative to axis L₁ may be varied by changing the configuration of sleeve 16. More specifically, apertures 40 a, 40 b can be aligned at an angle other than α₁. In these embodiments, first passageway 50 does not fall along transverse axis T₁ of nail 14. Thus, as bone engaging member 18 is slidably received within first passageway 50, bone engaging member 18 will contact either first projection 35 or second projection 36, but will not form an abutting relationship with first angled surface 31 a or second angled surface 32 a. However, the alternative arrangement is still suitable to fix bone engaging member 18 axially and rotationally relative to nail 14.

Referring again to FIGS. 1 and 2, a femur implantation procedure corresponding to system 10 is next described. The implant procedure generally includes forming a longitudinal hole into, and generally parallel with, the medullary canal from a position slightly medial to the tip of the greater trochanter 12 a. The longitudinal hole is sized to receive nail 14 therethrough. Preferably, the longitudinal hole is formed by drilling. Sleeve 16 is fitted over proximal end portion 14 a of nail 14 and sleeve 16 is secured to nail 14 by threading fasteners 20 into bore 28. As discussed above, system 10 can be used in either a first or second locking configuration depending on the rotational orientation of sleeve 16 relative to nail 14.

FIG. 1 illustrates system 10 in a first locking configuration corresponding to an antegrade configuration for the depicted femur 12. In this first locking configuration, sleeve 16 is secured to nail 14 with apertures 40 a, 40 b positioned relative to opening 26 of nail 14 to define passageway 52 along transverse axis T₂. Nail 14, with sleeve 16 secured thereto, is inserted through the longitudinal hole and into the medullary canal. A transverse hole is formed through femur 12 across the medullary canal corresponding to transverse axis T₂. The transverse hole intersects the medullary canal and is sized to receive bone engaging member 18 therein. Preferably this transverse hole also is formed by drilling. Bone engaging member 18 is inserted into the transverse hole and through passageway 52 formed by nail 14 and sleeve 16. As a result, member 18 is preferably secured against translation along axis L₁ or rotation about axis L₁ . When received in passageway 52, member 18 generally extends between a femur entry point slightly lateral to the greater trochanter 12 a to a terminal point below the base of neck 12 b. Generally parallel bores are formed through femur 12 transverse to the medullary canal and generally perpendicular to axis L₁ to align with transverse bores 24 a, 24 b of nail 14. Preferably these bores are also formed by drilling. Nail 14 is further locked into position by inserting locking bone screws 22 a, 22 b through femur 12 and into transverse bores 24 a, 24 b of nail 14.

FIGS. 2 and 5 illustrates system 10 in a second locking configuration corresponding to a retrograde arrangement relative to the depicted femur 12. In this second locking configuration, sleeve 16 is secured to nail 14 with apertures 40 a, 40 b positioned relative to opening 26 of nail 14 to define passageway 50 along transverse axis T₁. The medullary canal is accessed in generally the same manner as described in connection with FIG. 1. Nail 14, with sleeve 16 secured thereto, is inserted through the longitudinal hole medial to the greater trochanter 12 a and into the medullary canal. A transverse hole is drilled into femur 12 across the medullary canal corresponding to transverse axis T₁ and sized to receive bone engaging member 18 therein. Bone engaging member 18 is inserted into the transverse hole through passageway 50. So arranged, member 18 generally extends through neck 12 b into head 12 c. Generally parallel bores are formed through femur 12 transverse to the medullary canal and generally perpendicular to axis L₁ These bores are generally aligned with transverse bores 24 a, 24 b of nail 14. Nail 14 is further locked into position by inserting locking bone screws 22 a, 22 b through femur 12 and into transverse bores 24 a, 24 b of nail 14.

Next, a preferred method manufacturing nail 14 is described. This preferred method includes drilling a first bore through proximal portion 14 a in a direction corresponding to transverse axis T₁ (aligned at angle α₁). A second bore is then drilled through proximal portion 14 a corresponding to transverse axis T₂ (aligned at angle α₂) and intersecting the first bore at a point generally corresponding to the centerline of nail 14. The first and second bores are each sized to receive bone engaging member 18 therethrough. The first bore thereby defines first angled surface 31 a and second angled surface 32 a, and the second bore thereby defines third angled surface 31 b and fourth angled surface 32 b. The remaining material between lower surface 31 and upper surface 32 may then be removed to form opening 26 through nail 14, having projections 35, 36 as depicted.

FIG. 6 depicts intramedullary system 100 according to another embodiment of the present invention; where like reference numerals represent like features previously described in connection with system 10. System 100 is shown implanted in femur 12 and includes intramedullary rod or nail 14, transverse member 102, pin 103, locking screw 104 and set screw 105. System 100 also includes locking bone screws 22 a, 22 b. Although system 100 is shown implanted in human femur 12, system 100 could also be used in conjunction with other bones as would occur to one skilled in the art, including the tibia, humerus, radius, ulna and fibula to name a few. While system 100 could be used to treat the same indications as system 10 in the second locking configuration, as illustrated in FIG. 2 and discussed above, it is preferably used for fractures of the proximal portion of femur 12, and more preferably fractures between the neck 12 b and head 12 c. The same components of system 100 can be used to treat either a left or right femur by rotating transverse member 102 180 degrees relative to nail 14.

FIGS. 7–12 provide additional details concerning the structure and assembly of system 100. Referring to FIG. 7, various structural details of transverse member 102 and pin 103 are shown therein. Transverse member 102 defines a longitudinal centerline axis L₂ and includes a barrel connection portion 106 and a bone engaging portion 108. Connection portion 106 is generally cylindrical and has a side wall 110. Side wall 110 defines a passage 112 extending generally along axis L₂. Connection portion 106 also includes a proximal portion 106 a and a distal portion 106 b. Proximal portion 106 a includes an internal threaded portion 114 extending along a portion of passage 112. Distal portion 106 b defines an external inward taper 116 to promote ease of movement through bone when transverse member 102 is advanced into femur 12. Distal portion 106 b also defines an inner retaining lip 118 for provisionally maintaining bone engaging portion 108 in sliding engagement with connection portion 106, the operation of which will become apparent hereinafter.

A thru-hole 120 is formed through connection portion 106. Thru-hole 120 is generally cylindrical and has a diameter slightly greater than the outer diameter of proximal portion 14 a of nail 14. Alternately, thru-hole 120 could be elliptical or any other shape corresponding to proximal portion 14 a of nail 14. Additionally, thru-hole 120 and portion 14 a of nail 14 could be asymmetrical and of similar profile to prevent rotational movement of transverse member 102 relative to nail 14 when proximal portion 14 a is received within thru-hole 120. Similarly, if thru-hole 120 and portion 14 a of nail 14 where both tapered in the same direction and at about the same angle, the resulting tight engagement between transverse member 102 and nail 14 would aid in preventing rotational movement.

Thru-hole 120 is formed through connection portion 102 to provide a selected angular relationship with axis L₁ when nail 14 passes therethrough. This relationship corresponds to angle α₃ between axes L₁ and L₂, and is preferably in a range of about 130–145 degrees. More preferably, for system 100, angle α₃ is about 135 degrees and is equal to angle α₂ as depicted in FIG. 6. As will become apparent from later discussion, angle α₃ corresponds to the angle of fixation between transverse member 102 and nail 14.

Bone engaging portion 108 includes a proximal portion 108 a and a distal portion 108 b. A bone engaging and gripping thread 122 is formed on distal portion 108 b. Additionally or alternatively, a different bone gripping means may be utilized, such as a bone blade having distal portion 108 b formed from a plate with a helical twist, or such other means as would occur to those skilled in the art.

Proximal portion 108 a includes a hex recess 124 for receiving a driving tool (not shown), such as an Allen wrench, preferably suited to drive bone engaging portion 108 into neck 12 b and head 12 c of femur 12. Bone engaging portion 108 defines a longitudinal passage 126 extending therethrough and generally along axis L₂ to allow for the optional use of a guide wire (not shown) to aid in the insertion of bone engaging portion 108 into bone. Proximal portion 108 a is sized to be received within passage 112 of connection portion 106 to allow slidable movement of bone engaging portion 108 generally along axis L₂ over a predetermined range. A keeper 128 is provided on, in association with, or integral to proximal portion 108 a to provisionally maintain bone engaging portion 108 and connection portion 106 in a telescopic sliding relationship. Keeper 128 is comprised of a cylindrical sleeve that is preferably laser welded onto shaft 130 of bone engaging portion 108 after it has been positioned within connection portion 106. The outer diameter of keeper 128 is slightly smaller but in close tolerance with the inner diameter of passage 112.

Pin 103 is shown positioned within passage 112 of connection portion 106. FIGS. 8A and 8B additionally illustrate various structural details of pin 103. Pin 103 has a longitudinal centerline axis L₃ and includes a leading portion 132 integrally connected to a trailing portion 134. Leading portion 132 has a generally circular, elongated body and is sized to be received within opening 26 of nail 14. Leading portion 132 also includes an angled, annular engaging surface 135 configured to co-act with a surface of nail 14. Engaging surface 135 is aligned at an angle α₄ relative to axis L₃. Angle α₄ is in a range of about 130–145 degrees. Most preferably, angle α₄ should be approximately equal to angle α₂. Leading portion 132 additionally includes a tapered tip 136. Trailing portion 134 is provided with an externally threaded portion 137 configured to threadedly engage threaded portion 114 of connection portion 106. A hex recess 138 is defined by trailing portion 134 for receiving a driving tool (not shown), such as an Allen wrench, to advance pin 103 into portion 106 or remove pin 103 from portion 106 by turning in a corresponding rotational direction. In other embodiments, pin 103 additionally or alternatively has a different means for positioning relative to connection portion 106, such as a ratcheting mechanism, a cabling arrangement, or any other method capable of advancing pin 103 along axis L₂ as would occur to those skilled in the art.

In order to prevent pin 103 from migrating once positioned in a desired position within passage 112, system 100 includes locking screw 104. Locking screw 104 is provided with external threads 142 configured to threadedly engage threaded portion 114 of connection portion 106. A hex recess 144 is defined by trailing end 146 for receiving a driving tool (not shown), such as an Allen wrench, to rotationally advance locking screw 104 along connection portion 106. Locking screw 104 is axially advanced along axis L₂ until it tightly engages trailing portion 134 of pin 103. In other embodiments, system 100 additionally or alternatively includes another locking means as would normally occur to one skilled in the art to prevent pin 103 from migrating relative to connection portion 106.

To further aid in preventing pin 103 from rotating, loosening or migrating once positioned in a desired axial position within passage 112, system 100 includes set screw 105. Set screw 105 includes a threaded portion 150 and an elongated stem portion 152. Threaded portion 150 is configured to threadedly engage bore 29 of nail 14. Threaded portion 150 also includes a hex recess 154 for receiving a driving tool (not shown), such as an Allen wrench, to rotationally advance set screw 105 along bore 29. Elongated stem portion 152 is sized to be slidably received within longitudinal passage 30 of nail 14. Stem 152 also defines a tapered or contoured end 156 conforming with an outer surface of leading portion 132 of pin 103 to provide improved mechanical interlocking between set screw 105 and pin 103.

Referring generally to FIGS. 6, 7, 8A, and 8B, another embodiment of a femur implantation procedure in accordance with the present invention is described with respect to system 100. This femur implantation procedure generally includes forming a transverse passage into femur 12 that crosses the medullary canal and is sized to receive transverse member 102 therein. Preferably, this transverse passage is formed by drilling and begins at the lateral side of femur 12, extends into neck 12 b and terminates in head 12 c to orient transverse member 102 as depicted in FIG. 6. Also shown in FIG. 6, it is preferred that the transverse passage form an oblique angle approximately the same as angle α₃ with respect to axis L₁ or the medullary canal.

Next, transverse member 102 is introduced through the transverse passage with thru-hole 120 positioned to at least overlap the medullary canal of femur 12, and preferably to be generally centered with respect to the medullary canal of femur 12. At least a portion of bone engaging portion 108 is threaded into femur 12 at this stage. Preferably, bone engaging portion 108 is threaded into a portion of head 12 c of femur 12 by engaging hex recess 124 with a suitable tool and turning portion 108 in a corresponding rotational direction generally about axis L₂.

Notably, bone engaging portion 108 is telescopically received within passage 112 of connection portion 106 to allow axial movement of bone engaging portion 108 over a predetermined range along axis L₂. Keeper 128 cooperates with inner retaining lip 118 to prevent disengagement of bone engaging portion 108 from connection portion 106. The cooperation between inner retaining lip 118 and keeper 128 also acts to stabilize bone engaging portion 108, thus aiding in the sliding motion of bone engaging portion 108 to provide the preferred telescopic functioning of transverse member 102. Since connection portion 106 provisionally maintains bone engaging portion 108 in a captive, telescopic relationship, the alignment of bone engaging portion 108 along axis L₂ is always maintained. Thus, when the procedure includes turning thread 122 through neck 12 b of femur 12 and into head 12 c, head 12 c will become fixed in an angular relationship relative to transverse member 102. By maintaining the angular alignment between neck 12 b and head 12 c, and allowing them to slide telescopically relative to one another, system 100 can accommodate for changes during patient movement and expedite the bone healing process.

After transverse member 102 is inserted, an opening is formed, preferably by drilling, into and generally along the medullary canal from a position slightly medial relative to the tip of the greater trochanter 12 a and sized to receive nail 14 therethrough. Nail 14 is inserted through the longitudinal hole and into the medullary canal. Nail 14 passes through thru-hole 120 of connection portion 106. Thru-hole 120 of transverse member 102 receives nail 14 in a close sliding fit, thereby permitting limited axial and rotational movement of transverse member 102 along axis L₁ of nail 14. Transverse member 102 is longitudinally positioned on nail 14 so that passage 112 of connection portion 106 registers with opening 26 of nail 14. If desired, bone engaging portion is further advanced into the bone at this stage.

Next, pin 103 is axially advanced through passage 112 by engaging hex recess 144 with an appropriate tool and rotating in a corresponding direction. As threaded portion 137 of pin 103 engages threaded portion 114 of connection portion 106, leading portion 132 is slidably received within opening 26 to engage one or more surfaces 31 b, 32 b. Even if passage 112 and opening 26 are misaligned, in many instances tapered tip 136 allows pin 103 to self-center, thereby aiding in the insertion of leading portion 132 within opening 26. As pin 103 is slidably received within pathway 34 of opening 26 and guided along transverse axis T₂, leading portion 132 forms an abutting relationship with one or both of angled surfaces 31 b, 32 b. Pin 103 thus becomes oriented at angle α₂ relative to axis L₁, aiding in the fixation of transverse member 102 relative to nail 14. As pin 103 is further advanced through passage 112, engaging surface 135 is firmly pressed against nail 14 and transverse member 102 is pulled in a proximal direction. Correspondingly, an inner surface of transverse member 102 that borders thru-hole 120 is clamped against an outer surface of nail 14 while generally maintaining angle α₂ of transverse member 102 relative to axis L₁.

After securely clamping transverse member 102 and nail 14 together, generally parallel passages are formed, preferably by drilling through femur 12 transverse to the medullary canal and aligned with transverse bores 24 a, 24 b of nail 14. Nail 14 is further locked into position by inserting locking bone screws 22 a, 22 b through femur 12 and into transverse bores 24 a, 24 b of nail 14.

Referring to FIG. 9, system 160 of another embodiment of the present invention is illustrated; where reference numerals like those of previously embodiments refer to like features. System 160 includes transverse member 102′ which is the same as transverse member 102 except that pin 103′ is utilized in place of pin 103. FIGS. 10A, 10B, 11A and 11B illustrate selected details of pin 103′. Pin 103′ includes a leading portion 162 and a non-integral trailing portion 164. Leading portion 162 preferably has a generally circular, elongated body and is sized to be received within opening 26 of nail 14. Leading portion 162 also includes an angled, annular engaging surface 165 configured to co-act with a surface of nail 14. Engaging surface 165 is aligned at an angle α₄ relative to axis L₄ of pin 103′. Leading portion 162 additionally includes a tapered tip 166.

Leading portion 162 is articulated to trailing portion 164 to facilitate pivotal movement of portion 162 relative to portion 164. Trailing portion 164 includes externally threaded portion 167 configured to threadedly engage threaded portion 114 of connection portion 106. A hex recess 168 is defined by trailing portion 164 for receiving a driving tool (not shown), such as an Allen wrench, to advance pin 103 axially along connection portion 106. In other embodiments, pin 103′ is alternatively or additionally configured with a different means to be axially advanced through connection portion 106, such as a ratcheting mechanism or a cabling arrangement. In still other embodiments, techniques are utilized as would occur to one skilled in the art.

Leading portion 162 has a longitudinal centerline axis L₄ and trailing portion 164 has a longitudinal centerline axis L₅. Unlike pin 103, leading portion 162 and trailing portion 164 are not integral and are coupled to permit leading portion 162 to pivot relative to trailing portion 164. This pivoting or articulation permits angular variation of portion 162 relative to axis L₂. In one preferred embodiment, leading portion 162 includes a ball and socket joint 170 to provide the angular adjustment capability.

The rear portion of leading portion 162 defines a concave surface 174 generally centered about axis L₄. Projecting proximally from concave surface 174 along axis L₄ is stem 178. Stem 178 has a generally circular cross section, but also preferably defines a pair of parallel, opposing flats 180 a, 180 b. A ball member 182 is positioned at the end of stem 178 and is generally spherical-shaped. Trailing portion 164 defines a convex surface 184 generally centered about axis L₅ and configured to closely conform with concave surface 174 of leading portion 162. Trailing portion 164 also defines a transverse socket 186 extending partially therethrough and aligned generally perpendicular to axis L₅.

Transverse socket 186 has a diameter slightly larger than the diameter of ball member 182. Transverse socket 186 terminates at concave bottom surface 188. Concave bottom surface 188 substantially conforms with the outer surface of ball member 182. Trailing portion 164 also defines a longitudinal bore 190 aligned with axis L₅ Longitudinal bore 190 extends from convex surface 184 to transverse socket 186. Longitudinal bore 190 is outwardly tapered with wide end 190 a intersecting convex surface 184 and narrow end 190 b intersecting transverse socket 186, thus defining taper angle α₅ relative to axis L₅. Preferably, taper angle α₅ is between about 5 degrees and 20 degrees. Most preferably, taper angle α₅ is about 10 degrees. Trailing portion 164 further defines a transverse slot 192 extending partially therethrough and substantially aligned with transverse socket 186. Slot 192 has a width W extending along longitudinal bore 190 from convex surface 184 to transverse socket 186. Slot 192 has a depth sufficient to intersect narrow end 190 b of transverse bore 190. Height H of slot 192 is slightly greater than the distance between flats 180 a, 180 b of stem 190. Collectively, socket 186 and slot 192 are configured to receive ball member 182 and stem 178 therein, respectively.

In another embodiment of pin 103′, a flexible, readily deformable intermediate section is positioned between leading portion 162 and trailing portion 164 that may be additionally or alternatively used to provide means for allowing angular variation between axis L₄ and axis L₅. In still another embodiment, portion 162 is journaled to portion 164 by a shaft through a bore, permitting rotation of portion 162 relative to portion 164. In other embodiments, another suitable means for providing angular variation between axis L₄ and L₅ may alternatively or additionally be utilized as would occur to those skilled in the art.

As illustrated in FIG. 9, pin 103′ operates generally in the same manner as pin 103 described in connection with system 100. Although pin 103′ can be used in instances where angles α₂ and α₃ are substantially equal (as shown in FIG. 9), the more preferred application arises in configurations where angles α₂ and α₃ are different. The articulation of leading portion 162 relative to trailing portion 164 facilitates secure clamping to nail 14 despite a mismatch between the angled surfaces 31 a, 32 a, or 31 b, 32 b and the angular relationship of member 102′ to axis L₁ defined by thru-hole 120. For example, referring additionally to FIG. 12, angles α₂ and α₃ are about 135 and 140 degrees, respectively, relative to axis L₁. Preferably, the pivot range of leading portion 162 accommodates a range of different angular orientations of thru-hole 120 corresponding to α₃. In one more preferred range, leading portion 162 pivots to accommodate a variation of angle α₃ from about 130 to about 145 degrees.

In one preferred implantation procedure, transverse member 102′ and nail 14 are implanted in accordance with the same procedure for inserting bone engaging member 108, connection portion 106 and nail 14, with the engagement of pin 103′ in place of pin 103. For pin 103′, ball member 182 is inserted into socket 186 by aligning flats 180 a, 180 b of stem 178 with slot 192 and then guiding ball member 182 within transverse socket 186 until ball member 182 is positioned adjacent concave bottom surface 188. A slight rotation or angulation of leading portion 162 relative to trailing portion 164 securely engages the two portions. As a result, leading portion 162 is rotatably coupled to trailing portion 164 by ball and socket joint 170. Thus, leading portion 162 can rotate freely over a predetermined range within passage 112 as limited by taper angle α₅. In one preferred embodiment, taper angle α₅ permits angular variation between leading portion 162 and trailing portion 164 of about 10 degrees in any direction. The assembly of leading portion 162 to trailing portion 164 may be performed during the implantation procedure just before insertion into passage 112 or in advance of the procedure as desired.

Once leading portion 162 and trailing portion 164 are assembled, Pin 103′ is advanced through passage 112 of connection portion 106 by engaging hex recess 168 and turning in the appropriate rotational direction. Pin 103′ is slidably received within pathway 34 of opening 26 and leading portion 162 is guided along transverse axis T₂ to form an abutting relationship with one or both of angled surfaces 31 b, 32 b. If, as mentioned above, thru-hole 120 is disposed in connection portion 106 in correspondence to a different angle α₃ relative to axis L₁ (such as 140 degrees), leading portion 162 is forced to pivot relative to trailing portion 164 and thereby aligns at angle α₂ (such as 135 degrees). As trailing portion 164 is tightened in connection portion 106, a rigid, secure construct forms between transverse member 102′ and nail 14 as described in connection with the operation of system 100, except that pin 103′ may pivot, contacting an inner surface of connection portion 106 as illustrated in FIG. 12. Notably, like system 10, system 100 and 160 may be reconfigured to accommodate either the left or right femur or an antegrade or retrograde application; however, in other embodiments of the present invention, rod 14 may be modified to define only one generally linear pathway therethrough.

Referring now to FIG. 13, system 195 according to another embodiment of the present invention is illustrated; where reference numerals of previously described embodiments refer to like features. Preferably, system 195 is implanted in femur 12 as shown, and includes intramedullary rod or nail 14, set screw 105, and locking bone screws 22 a, 22 b, 22 c. In other embodiments, system 195 may be used in conjunction with other bones as would occur to one skilled in the art, such as the tibia, humerus, radius, ulna, or fibula to name a few. Additionally, the same components of system 195 can be used to treat either a left or right femur by simply rotating nail 14 180 degrees relative to longitudinal axis L₁. Unlike systems 10, 100 and 160; system 195 positions nail 14 with the proximal and distal end portions reversed within femur 12 corresponding to implantation of nail 14 in a retrograde direction. Unlike existing systems, nail 14 need not be modified to operate in a retrograde direction. Indeed, nail 14 may be used in either an antegrade direction, as illustrated in connection with systems 10, 100, and 160, or a retrograde direction as illustrated in FIG. 13.

One preferred implant procedure for system 195 includes forming a longitudinal hole along femur 12, intersecting the medullary canal from a point generally central to distal end portion 12 d. The longitudinal hole is sized to receive nail 14 therethrough and is preferably formed by drilling into femur 12. Nail 14 is inserted through the longitudinal hole and into the medullary canal. A pair of generally parallel, transverse passageways are formed, preferably by drilling, through femur 12 transverse to and intersecting with the medullary canal. These passageways are in registry with opening 26 and transverse bore 28, respectively. Nail 14 is locked into position by inserting locking bone screws 22 a, 22 b into the transverse passageways and correspondingly through opening 26 and transverse bore 28. Another transverse passageway is drilled through femur 12 across the medullary canal and intersecting therewith that is generally aligned with transverse bore 24 c formed in distal portion 14 b of nail 14. Nail 14 is further locked into position by inserting locking bone screw 22 c into this distal transverse passageway and correspondingly through transverse bore 24 c. Although system 195 does not require a sleeve to lock bone screws 22 a, 22 b into position relative to nail 14, as discussed below, such a feature may optionally be utilized.

Referring now to FIG. 14, shown is bone treatment system 200 according to yet another embodiment of the present invention; where reference numerals of previously described embodiments refer to like features. System 200 is shown implanted in femur 12 and includes intramedullary nail 14, sleeve 202, bone engaging members 204, 205 and biasing sleeve 202. Preferably, system 200 is utilized to treat fractures of the human femur, but may be used in conjunction with any other bone as would occur to those skilled in the art. Additionally, while system 200 can be used with any nail and sleeve configuration, it is preferably used in conjunction with retrograde implantation of nail 14 as described in connection with FIG. 13 herein.

In FIG. 14, opening 26 extends generally along transverse centerline axis T₃ and transverse bore 28 extends generally along transverse centerline axis T₄. Opening 26 is bounded by a bearing surface 26 a and bore 28 is bounded by a bearing surface 28 a. Sleeve 202 has a generally cylindrical shape and defines a proximal end 202 a, a distal end 202 b, and a side wall 208. Sleeve 202 is sized to fit over proximal end portion 14 a of nail 14. Distal end 202 b is therefore open to allow for passage of proximal end portion 14 a. Sleeve 202 defines an inwardly tapered edge 210, terminating at distal end 202 b, to facilitate movement of sleeve 202 through bone. Proximal end 202 a is also open to allow for the passage of nail insertion and extraction instrumentation (not shown). The interior surface of side wall 208 immediately adjacent proximal end 202 a defines a threaded portion 211. Side wall 208 also defines two sets of opposing apertures 212 a, 212 b and 214 a, 214 b. Apertures 212 a, 214 a oppose apertures 212 b, 214 b in a direction along axes T₃, T₄, respectively. Aperture sets 212 a, 212 b, and 214 a, 214 b are generally circular and are aligned and sized to respectively receive bone engaging members 204, 205 therethrough. Apertures 212 a, 212 b define circumferential engaging surfaces 213 a, 213 b, respectively, and apertures 214 a, 214 b define circumferential engaging surfaces 215 a, 215 b, respectively.

Bone engaging member 204 includes a proximal end portion 204 a opposite a distal end portion 204 b. Bone engaging member 204 has a generally circular cross section and preferably has a diameter of about 5.5–6.5 millimeters for a femur application. Distal end portion 204 b includes thread 216 for engaging and gripping bone. Alternatively or additionally, member 204 may include a different bone engaging or gripping means such as a bone blade having distal end portion 204 b formed from a plate with a helical twist or an expansion device. Bone engaging member 205 includes a proximal end 205 a and a distal end 205 b and is preferably configured the same as bone engaging member 204.

System 200 includes biasing end cap 220. End cap 220 is generally circular and includes a first threaded portion 222 configured to threadingly engage threaded portion 211 of sleeve 202. A second threaded portion 224 is configured to threadingly engage longitudinal bore 29 of nail 14. End cap 220 proximally terminates in an enlarged, flat end portion 226 having protruding flange 228. Flat end portion 226 also defines hex recess 230 for receiving a driving tool (not shown).

System 200 is utilized in accordance with one preferred femur implantation procedure by inserting nail 14 as described in connection with FIG. 13, except, proximal end 14 a also carries sleeve 202 thereon by loosely threading end cap 220 into sleeve 202 and rod 14. Accordingly, protruding flange 228 of flat end portion 226 bears against proximal end 202 a of sleeve 202. With sleeve 202 so oriented, apertures 212 a, 212 b are generally in alignment with transverse bore 28 along axis T₄ to define passageway 232. Correspondingly, apertures 214 a, 214 b are generally aligned with opening 26 along transverse axis T₃ to defined passageway 234.

Once the nail 14 and sleeve 202 are in place within femur 12, two transverse passages are formed through the bone that are in registry with passageways 232, 234. Next, bone engaging members 204, 205 are received through the bone and passageways 232, 234, respectively. Once bone engaging members are in place. Sleeve 202 is biased by further tightening of end cap 220. As end cap 220 is tightened, is moves sleeve 202 and nail 14 in opposite directions along axes L₁. Correspondingly, surfaces 213 a, 213 b move to bear against bone engaging member 204 and engaging surfaces 214 a, 214 b bear against bone engaging member 205. In turn, bone engaging member 204 is tightly clamped against bearing surface 26 a of opening 26 and bone engaging member 205 is tightly clamped against bearing surface 28 a of bore 28. The tight engagement between bone engaging members 204, 205 and bearing surfaces 26 a, 28 a thereby clamps bone engaging members 204, 205 into position relative to nail 14 and prevents lateral migration. Locking nuts, which have in the past been used to prevent such lateral migration, are generally not needed for system 200, so that additional surgical incisions normally required to engage locking nuts onto the bone engaging members need not be made and soft tissue irritation commonly associated with the presence of the locking nuts is also eliminated. Preparations and implantation of one or more bone engaging members may optionally be performed at distal end 14 b of nail 14 .

In an alternative embodiment, end cap 220 does not include first threaded portion 222. Thus, as threaded portion 224 engages longitudinal bore 29 of nail 14, flange 228 of flat end portion 226 contacts proximal end 202 a of sleeve 202 to advance sleeve 202 in a distal direction relative to nail 14. In still another embodiment, end cap 220 does not include second threaded portion 224. Thus, as threaded portion 222 engages threaded portion 211 of sleeve 202, flat end 222 a of threaded portion 222 is forced into contact with the proximal end of nail 14, thereby advancing sleeve 202 in a proximal direction relative to nail 14. In yet another embodiment of system 200, the biasing means consists of a spring member operably captured between nail 14 and sleeve 202. The spring member is configured to urge sleeve 202, nail 14, or both to clamp bone engaging members 204, 205.

Referring now to FIG. 15, intramedullary system 300 according to still another embodiment of the present invention is illustrated; where reference numerals of previously described embodiments refer to like features. System 300 is shown implanted in femur 12 and includes elongated intramedullary nail 302, positioning device 304, bone engaging member 306 and locking bone screw 308. Femur 12 includes a fracture site 301, separating femur 12 into two portions 12 f, 12 e. Fracture site 301 is shown in a compressed state (i.e., portions 12 f, 12 e are being pushed together). Although system 300 is shown implanted in femur 12, system 300 could also be used in conjunction with other bones such as the tibia, humerus, radius, ulna and fibula to name a few. Additionally, the same components of system 300 can be used to treat either a left or right femur by simply rotating nail 302 180 degrees relative to axis L₆. Although FIG. 15 illustrates nail 302 implanted within femur 12 in a retrograde direction, it is understood that system 300 could also be implanted with nail 302 in an antegrade direction.

FIGS. 15 and 16 show various structural details of nail 302. It should be understood that nail 302 can take on a number of configurations, including that of nail 14 illustrated and described above. However, in a preferred embodiment, nail 302 is configured as described below. Nail 302 includes a proximal end portion 302 a and a distal end portion 302 b. Nail 302 also defines a longitudinal axis L₆ running along the length of nail 302 between proximal end portion 302 a and distal end portion 302 b. Proximal end portion 302 a preferably has a diameter of about 11–12 millimeters for an adult human femur application. The diameter of the remainder of nail 302 can be varied depending upon the requirements of the fixation procedure and the surgeon's preference. While nail 302 has a generally circular cross section, other suitable shapes are also contemplated as would occur to one skilled in the art.

Nail 302 defines a passage 309 extending therethrough along axis L₆ line to allow for the optional use of a guide wire (not shown) to aid in the insertion of nail 302 in femur 12. Distal end portion 302 b defines parallel transverse bores 310 b, 310 c, each sized to receive locking bone screw 308. Distal end portion 302 b also defines transverse bore 310 a, aligned generally perpendicular to transverse bores 310 b, 310 c and also sized to receive locking bone screw 308.

Proximal end portion 302 a defines an elongated, longitudinal opening 312 bounded by side walls 313 and sized to receive bone engaging member 306 therein. Opening 312 laterally extends through nail 302 and is elongated in the direction of longitudinal axis L₆. Opening 312 has a first end portion 312 a and an opposing second end portion 312 b. Proximal end portion 302 a of nail 302 also defines a longitudinal passage 314 extending generally along axis L₆ and having a generally circular cross-section. Longitudinal passage 314 intersects opening 312 and terminates in a generally concave bottom surface 316. A threaded portion 318 is defined about a portion of longitudinal passage 314. Proximal end portion 302 a also defines a transverse bore 320 extending through nail 302 generally perpendicular to axis L₆ and aligned with opening 312. Bore 320 is sized to receive bone engaging member 306 therein.

Referring to FIG. 17, therein is shown nail 302, positioning device 304 and bone engaging member 306 as assembled within system 300. Positioning device 304 is shown positioned within longitudinal passage 314 and includes a first portion 322 and a second portion 324. First portion 322 includes a head 326 and a threaded stem 328 extending therefrom generally along longitudinal axis L₆. Head 326 is substantially circular and has an outer diameter generally corresponding to the outer diameter of nail 302. Head 326 also includes a hex recess 330 for receiving a driving tool (not shown), such as an Allen wrench. The diameter of threaded stem 328 is less than the diameter of head 326, thereby defining an annular shoulder 332.

Second portion 324 defines a generally circular, elongated body 333 having a diameter slightly less than the diameter of longitudinal passage 314. Second portion 324 also defines an internally threaded portion 334 extending generally along longitudinal axis L₆ and configured to threadedly engage threaded stem 328 of first portion 322. Threaded portion 334 has a depth slightly greater than the length of threaded stem 328. The end of second portion 324 opposite threaded portion 334 terminates into a generally convex outer surface 336 that substantially corresponds to concave bottom surface 316 of longitudinal passage 314. Second portion 324 also defines a transverse opening 338 extending therethrough generally perpendicular to longitudinal axis L₆. Opening 338 is bounded by inner surface 339 and is sized to receive bone engaging member 306 therein.

FIG. 17 illustrates a first operational position of system 300. Positioning device 304 (including first and second portions 322, 324) is shown inserted within longitudinal passage 314 of nail 302. Opening 338 of second portion 324 is positioned adjacent second end portion 312 b of opening 312 and generally aligned with opening 312 to define a passageway 340. Bone engaging member 306 is shown inserted through passageway 340. Threaded stem 328 of first portion 322 is partially threadedly engaged within threaded portion 334 of second portion 324. First portion 322 can be rotated by placing a driving tool (not shown) within hex recess 330 and turning in a clockwise or counterclockwise direction as appropriate. Second portion 324 is prevented from rotating in correspondence with first portion 322 because of engagement between bone engaging member 306 against sidewalls 313 of opening 312. In one embodiment, threaded stem 328 and threaded portion 334 each have right-handed threads. In this embodiment, as first portion 322 is rotated in a clockwise direction, shoulder 332 of head 326 bears against nail 302, and second portion 324 correspondingly moves toward first portion 322 generally along longitudinal axis L₆. As the position of second portion 324 is adjusted along axis L₆, inner surface 339 of opening 338 bears against bone engaging member 306 and correspondingly adjusts the position of bone engaging member 306 along the length of opening 312.

FIG. 18 illustrates a second operational position of system 300 in which first portion 322 is rotated in a clockwise direction until bone engaging member 306 is positioned adjacent first end portion 312 a of opening 312. It should be understood, however, that bone engaging member 306 can be variably positioned anywhere along the length of opening 312. It should further be understood that the terms “first operational position” and “second operational position” are not necessarily indicative of the initial position and adjusted position of bone engaging member 306. For example, bone engaging member 306 could originate in a position adjacent first end portion 312 a and be variably positioned anywhere along the length of opening 312.

In other embodiments of system 300, nail 302 defines a keyway extending along the length of longitudinal passage 314 generally parallel with axis L₆. Additionally, second portion 324 defines a key along its length which generally corresponds to the keyway defined in nail 302. Preferably, the key is radially positioned so that when it is slidably received within the keyway, opening 338 of second portion 324 will correspondingly align with opening 312 of nail 302. Alternatively, the key could be defined along the length of second portion 324 and, correspondingly, the keyway could be defined along the length of longitudinal passage 314 of nail 302.

Having described selected structural and operational features of nail 302 and positioning device 304, the operational characteristics of system 300 will now be described in further detail. Referring back to FIG. 15, nail 302 is shown implanted in femur 12. Distal end 302 b of nail 302 is anchored to portion 12 e of femur 12 by inserting locking bone screw 308 into portion 12 e and through transverse bore 310 a (not shown) of nail 302. Proximal end 302 a of nail 302 is anchored to portion 12 f of femur 12 by inserting bone engaging member 306 into portion 12 f and through passageway 340 (defined by aligning opening 338 with opening 312). Preferably, bone engaging member 306 is initially positioned adjacent or near second end portion 312 b of opening 312. As first portion 322 of positioning device 304 is rotated in a clockwise direction, bone engaging member 306 is correspondingly repositioned along the length of opening 312, and more specifically is transferred toward first end portion 312 a. Because bone engaging member 306 is anchored to portion 12 f of femur 12, portion 12 f is correspondingly moved in the direction of arrow “A”, while portion 12 e of femur 12 remains stationery, securely anchored to distal end 302 b of nail 302. Thus, portion 12 f of femur 12 is repositioned away from portion 12 e, thereby distracting fracture site 301.

One preferred procedure for implanting system 300 within femur 12 includes forming a longitudinal hole along the medullary canal from a point generally central to the distal end portion 12 d of femur 12. Preferably this hole is formed by drilling sized to receive nail 302 therethrough. Positioning device 304 is inserted in longitudinal passage 314 of nail 302 and nail 302 is inserted through the longitudinal hole and into the medullary canal. It should be understood that positioning device 304 could alternatively be inserted in longitudinal passage 314 after nail 302 has been implanted in femur 12. A first passage is formed through femur 12 transverse to the medullary canal and generally aligned with transverse bore 310 a (not shown) formed in distal portion 302 b of nail 302. A second passage is formed through femur 12 transverse to the medullary canal and generally aligned with passageway 340. Preferably, these transverse passages are formed by drilling. Locking bone screw 308 is threaded into the first passage, passing through transverse bore 310 a. Bone engaging member 306 is threaded into the second passage, passing through passageway 340. At this point, fracture site 301 can be distracted by following the operational procedure described above. Dashed line 301 a of FIG. 15 corresponds to the position of the fractured end of portion 12 f after distraction in accordance with one embodiment of the present invention.

Referring now to FIG. 19, intramedullary system 400 according to yet another embodiment of the present invention is illustrated; where like reference numerals of previously described embodiments refer to like features. System 400 is shown implanted in femur 12 and includes elongated intramedullary nail 302, positioning device 304′, bone engaging member 306 and locking bone screw 308. Femur 12 includes a fracture site 301′, separating femur 12 into two portions 12 f, 12 e. Fracture site 301′ is shown in a distracted state (i.e., portion 12 a, 12 b are spaced apart relative to one another). Although system 400 is shown implanted in femur 12, system 400 could also be used in conjunction with other bones as would occur to one skilled in the art, including the tibia, humerus, radius, ulna and fibula, to name a few. Additionally, the same components of system 400 can be used to treat either a left or right femur by simply rotating nail 302 180 degrees relative to axis L₆. Although FIG. 19 illustrates nail 302 implanted within femur 12 in a retrograde direction, it is understood system 400 may also be implanted with nail 302 in an antegrade direction.

Referring to FIG. 20, therein is shown nail 302, positioning member 304′ and bone engaging member 306 as assembled within system 400. Positioning member 304′ is shown positioned within longitudinal passage 314 and includes a first portion 402 and a second portion 404. First portion 402 includes a threaded upper portion 406 and an elongated lower portion 408 extending therefrom along longitudinal axis L₆. Upper portion 406 is configured to threadedly engage threaded portion 318 of longitudinal passage 314. Upper portion 406 also includes a hex recess 410 for receiving a driving tool (not shown), such as an Allen wrench. Lower portion 408 has a generally circular body having an outer diameter slightly less than the diameter of longitudinal passage 314. A transverse passage 412 extends through lower portion 408 and is aligned generally perpendicular to axis L₆. The end of lower portion 408 opposite its threaded portion terminates in a generally flat surface 414.

Second portion 404 has a circular body having an outer diameter generally corresponding to the outer diameter of lower portion 408 of first portion 402. Second portion 404 defines an internally threaded portion 416 extending generally along axis L₆ for engaging insertion instrumentation (not shown). One end of second portion 404 defines a generally flat surface 418, corresponding to surface 414 of lower portion 408. The opposing end of second portion 404 terminates in a generally convex outer surface 420 substantially corresponding to concave bottom surface 316 of longitudinal passage 314. Second portion 404 also defines a transverse opening 422 extending therethrough generally perpendicular to axis L₆. Opening 422 is bound by inner surface 424 and is sized to receive bone engaging member 306 therein.

FIG. 20 illustrates a first operational position of system 400. Positioning device 304′ (including first and second portions 402, 404) is shown inserted within longitudinal passage 314 of nail 302. Opening 422 of second portion 404 is positioned adjacent first end portion 312 a of opening 312 and generally aligned with opening 312 to define a passageway 426. Bone engaging member 306 is shown inserted through passageway 426. Upper portion 406 of first portion 402 is partially threadedly engaged within threaded portion 318 of longitudinal passage 314. First portion 402 can be rotated by placing a driving tool (not shown) within hex recess 410 and turning first portion 402 in a clockwise or counterclockwise direction. In one embodiment, threaded upper portion 406 and threaded portion 318 each have right-handed threads. In this embodiment, as first portion 402 is rotated in a clockwise direction, it will be advanced through longitudinal passage 314 generally along axis L₆. As first portion 402 is advanced, surface 414 will engage surface 418 of second portion 404, thereby correspondingly advancing second portion 404 through longitudinal passage 314 generally along axis L₆. As the position of second portion 404 is adjusted along axis L₆, inner surface 424 of opening 422 bears against bone engaging member 306 and correspondingly adjusts the position of bone engaging member 306 along the length of opening 312.

FIG. 21 illustrates a second operational position of system 400 in which first portion 402 is rotated in a clockwise direction until bone engaging member 306 is positioned adjacent second end portion 312 b of opening 312. It should be understood, however, that bone engaging member 306 can be variably positioned anywhere along the length of opening 312. It should further be understood that the terms “first operational position” and “second operational position” are not necessarily indicative of the initial position and adjusted position of bone engaging member 306. For example, bone engaging member 306 could originate in a position adjacent second end portion 312 b and be variably positioned anywhere along the length of opening 312.

When bone engaging member 306 is positioned adjacent second end portion 312 b of opening 312, transverse passage 412 of upper portion 406 will become aligned with transverse bore 320 of nail 302, thereby defining a passageway 430. A second bone engaging member 306 can then be inserted through passageway 430 to prevent further rotational movement of first portion 402 relative to nail 302. However, if transverse passage 412 and transverse bore 320 cannot be aligned to form passageway 430, a second bone engaging member 306 cannot be used. In this case, in order to prevent first portion 402 from rotating and migrating relative to nail 302, a locking set screw can be threadedly advanced along threaded portion 318 of nail 302 until it tightly engages upper portion 406.

Having described selected structural and operational features of positioning device 304′, the operational characteristics of system 400 will now be described in further detail. Referring back to FIG. 19, nail 302 is shown implanted in femur 12 and is anchored to portions 12 a and 12 b in substantially the same manner as described above in system 300. Preferably, bone engaging member 306 is initially positioned adjacent or near first end portion 312 a of opening 312. As first portion 402 of positioning device 304′ is rotated in a clockwise direction, bone engaging member 306 is correspondingly repositioned along the length of opening 312, and more specifically is transferred toward second end portion 312 b of opening 312. Because bone engaging member 306 is anchored to portion 12 f of femur 12, portion 12 f is correspondingly moved in the direction of arrow “B”, while portion 12 e of femur 12 remains stationary, securely anchored to distal end 302 b of nail 302. Thus, portion 12 f of femur 12 is repositioned toward portion 12 e, thereby compressing fracture site 301′. Dashed line 301 b of FIG. 19 corresponds to the fractured end of portion 12 f after compression in accordance with one embodiment of the present invention.

One preferred procedure for implanting system 400 within femur 12 is substantially identical to the procedure for implanting system 300, except a compression operation as described above is performed instead of the distraction operation as described in connection with system 300.

The components of systems 10, 100, 165, 195, 200, 300 and 400 may be fabricated from any suitably strong, bio-compatible material such as stainless steel, titanium, chrome-cobalt, or any other material which would occur to those skilled in the art.

In still further aspects of the invention, there is provided alternative bone stabilizing components and bone opening preparation instruments. Referring to FIGS. 22 through 25C, there is shown a unique bone stabilizing system 500. FIG. 22 illustrates an intermedullary nail 502 and a cooperable epiphyseal stabilizing plate 504. Nail 502 includes internally threaded aperture 506 defined between extensions 507. Plate 504 includes aperture 512 which is preferably sized to prevent passage of nail 502. Locking element 508 is provided and includes an externally threaded posted 510 adapted to pass through aperture 512 and threadedly engage internally threaded aperture 506. It will be understood that locking element 508 may be used to interconnect nail 502 to plate 504. While the configuration of a locking member having a smaller diameter externally threaded post has been disclosed herein as a preferred embodiment, it will be understood that a portion of nail 502 may be configured with a reduced diameter externally threaded post that extends through aperture 512 and locking member may be an internally threaded nut. This and other alternative configurations of locking arrangements using various locking members may be utilized with the present invention.

Plate 504 includes a distal surface 514 disposed on plate wall 515 that is substantially planar and extends in parallel alignment with plate longitudinal axis 532. The terms distal and proximal in reference to plate 504 are utilized to describe those features having more distal or proximal locations to nail 502 as shown in FIG. 22. Depending on use and orientation, the same features could be referred to as upper and lower features. Further, plate 504 includes opposing longitudinal side walls 516 and 518 extending substantially parallel to longitudinal axis 532. End wall 520 extends between side walls 516 and 518. Side walls 516 and 518 and end wall 520 have a height transverse to the longitudinal axis. The wall height of the device is substantially greater than plate wall 515 thickness. As soon in FIG. 22, the difference in wall height and central plate thickness defines recess 524. Further, plate 504 does not include an end wall opposing end wall 520, thus recess 524 is open adjacent leading end 522. It will be appreciated (and as shown more clearly in FIG. 25B) that leading end 522 is defined by side walls 516 and 518, and plate wall 515. Preferably, the leading edges of each of the defining walls decreases in thickness such that leading end 522 is configured as a blade to penetrate bone.

An alternative plate 550 is shown in FIG. 25A. Plate 550 includes plate wall 560, opposing side walls 562 and 564, and end wall 566. As previously described with respect to the embodiment shown in FIG. 22, the combination of these walls define recess 568 shown in FIG. 25B. With further reference to FIG. 25B, plate wall 560 includes a tapered leading edge 561. Similarly, side walls 562 and 564 include tapered leading edges 563 and 565, respectively. Thus, it will be understood that the leading end 552 is adapted to penetrate bone or other tissue. As viewed from trailing end 554, end wall 566 closes recess 568 and may provide a surface for impaction of the device into the bone. In contrast to the embodiment of FIG. 22, plate 550 includes a slot 556 that may variably receive elongated members therethrough. Slot 556 includes scallops 558 that may selectively engage locking components at any of the semi-circular apertures along the slot. While a slot and scallop configuration has been shown as a preferred combination, it will be understood by those skilled in the art that additional combinations may be used to provide adjustable fixation, such as for example but without limitation; serrated washers and plates, expandable fixation elements, and external clamps.

FIGS. 23 and 24 shown the apparatus of FIG. 22 inserted into at least two long bones where the invention may find application. It will be understood that these examples are provided for the purpose of illustration and not as a limitation of the use of the present invention. Referring to FIG. 23, nail 502 has been positioned within the intermedullary canal of femur 540. Next, leading end 522 is positioned against the exterior of femur 540 near the tip 503 of nail 502. Plate 504 is aligned with tip 503 such that recess 524 will receive at least a portion of tip 503 as the plate is advanced into the bone. Longitudinal axis 530 of the nail and longitudinal axis 532 of the plate are positioned substantially transverse to each other. With recess 524 in alignment with tip 503, the trailing wall end 520 may be impacted to drive plate 504 into the bone. As shown in a preferred embodiment, plate 504 is advanced into the bone until aperture 512 is in alignment with aperture 506. It will be understood that side walls 516 and 518 may be spaced to substantially match the diameter of tip 503 and thereby forming a channel to control movement of plate 504 relative to nail 502. With appropriate selection of plate length, end wall 520 may rest against the exterior of femor 540. With aperture 512 in alignment with aperture 506, locking member 508 may be inserted to join the components one to the other. It is contemplated that plate 504 and nail 502 may include cooperating components to prevent rotational movement therebetween.

FIG. 24 illustrates the apparatus of FIG. 22 inserted into a tibia 542. Nail 502 is positioned in the intermedullary canal of tibia 542. Leading edge 522 of plate 520 is aligned with the nail tip and the plate is driven into the bone by force applied adjacent end wall 520. Locking member 508 then locks the components together.

Another feature of the present invention relates to preparation of tissue openings to receive fixation devices. More specifically, reamers have been utilized to prepare intermedullary canals and other openings to receive implants. It is often assumed that naturally occurring intermedullary canals are substantially uniform in bone density radiating outwardly from the longitudinal axis of a long bone. In some instances these canals have formed in a non-uniform manner. Further, previous injury to adjacent bone may result in non-uniform narrowing of the canal as the fracture or fractures heal. Thus, the present invention provides a reamer that may be selectively operated to remove bone or other tissue in a non-cylindrical and non-uniform manner.

Referring to FIGS. 26A through 26D, there is shown a reaming head 600 in accordance with a preferred aspect of the present invention. Although not shown, it will be appreciated that reaming head 600 will be interconnected with an elongated shaft. Reaming head 600 includes a truncated cylindrical body 602. As shown in FIG. 26C, cylindrical body 602 extends approximately 240 degrees and is interrupted for the remaining 120 degrees by cutting area 607. Cylindrical body 602 defines a maximum outer diameter of the reaming head 600 and extends in substantial alignment with longitudinal axis 620. Distal end 605 includes a domed portion 606 substantially continuous with cylindrical body 602. Within cutting area 607, cutting blade 608 extends in longitudinal alignment with axis 620. Cutting blade 608 extends along the length opposite cylindrical body and domed portion 606. Reaming head further includes cylindrical taper 604 and cylindrical portion 616. Adjacent proximal end 607 there is a tool attachment mechanism defined by protrusion 612 and shoulder 614. As shown in FIGS. 26C and 26D, cannula 610 extends through reamer head in alignment with longitudinal axis 620.

In use, reaming head 600 may be interconnected with a shaft by a tool mechanism cooperable with tool attachment features 612 and 614. The attachment is provides such that the reaming head may be securely fastened to a shaft and oscillatory motion may be transmitted to the reaming head. The reaming head 600 may then been inserted into a bone opening 702 (FIG. 27). In a preferred aspect, this opening may be an intermedullary canal (although not completely empty, the tissue density within the canal makes passage of instruments relatively easy in comparison to the surrounding cortical bone 700). As shown in FIG. 27, opening 702 has been narrowed by bone growth 706. It will be understood that a cutting device providing a uniform cylindrical bone removal may be shifted off the center (guide wire 710 extends through the center) of the medullary canal and remove a substantial portion of bone wall 704. Utilizing reaming head 600, dome 606 and body portion 602 may be positioned adjacent bone wall 704 while cutting blade is positioned adjacent bone growth 706. It will be understood that dome 606 tends to center the reaming head and cylindrical body 602 bears against the opposing bone wall 704 the operator intends to preserve. Reaming head 600 may then be oscillated to remove bone growth 706 and restore bone opening 702 to extend in a substantially centralized position (shown by dashed lines 708) within bone 700. It is contemplated that reaming head may be oscillated through an arc of between 20 and 200 degrees although in a preferred aspect the arc of oscillation is between 80 and 120 degrees. Further, the oscillator force may be generated by hand force or interconnection with a power supply as know to those skilled in the art. It will be appreciated that reaming head 600 may be advanced along a path to create the desired length of bone opening. Further, reaming head 600 may be utilized to establish an entry opening through the external cortical bone and into communication with an intermedullary canal. The present invention may be particularly useful were surrounding structures tend to force the cutting head off the intended alignment. Moreover, in a preferred aspect, guide wire 710 has been positioned along the desired path and confirmed by X-ray or other visualization. Reaming head 600 is then advanced along guide wire 710 to remove any bone protrusions that interfere with its passage through bone opening 702.

While the invention has been illustrated and described in detail in the drawings and foregoing discussion, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected. 

1. A reaming head, comprising: a body having a longitudinal axis and an outer surface defining a longitudinally extending substantially cylindrical configuration extending over a majority of the circumference of said outer surface and a truncated surface interrupting said substantially cylindrical configuration; a cutting element positioned in said truncated surface; a transverse axis, transverse to the longitudinal axis, the transverse axis intercepting at least a portion of the substantially cylindrical configuration, and intercepting at least a portion of the cutting element; wherein said cutting element is a blade spaced from said outer surface and extending in substantial alignment with said longitudinal axis.
 2. The reaming head of claim 1, further including a rounded leading surface adjacent said cylindrical configuration.
 3. The reaming head of claim 1, wherein said longitudinally extending substantially cylindrical configuration is substantially uninterrupted.
 4. The reaming head of claim 1, wherein said longitudinally extending substantially cylindrical configuration consists essentially of a single longitudinally extending substantially cylindrical configuration.
 5. The reaming head of claim 1, wherein said cutting element consists essentially of a single cutting element.
 6. The reaming head of claim 1, further comprising a guide wire lumen.
 7. A method of eccentric reaming, comprising: providing a reaming head having an outer surface with a cylindrical portion and a cutting element positioned opposite said cylindrical portion and configured for cutting upon oscillatory motion; inserting the reaming head into a bone opening; positioning said cylindrical portion adjacent tissue to be preserved; positioning the cutting surface adjacent tissue to be removed; oscillating the head of the reamer to cause the cutting surface to remove tissue.
 8. The method of claim 7, wherein said oscillating occurs over a range of 20 to 180 degrees.
 9. The method of claim 8, wherein said oscillating occurs over a range of 80 to 120 degrees.
 10. The method of claim 7, wherein said inserting further includes positioning a wire guide into the tissue and positioning the reamer over the wire guide prior to said inserting.
 11. A reaming head, comprising: a body having a longitudinal axis and an outer surface defining a longitudinally extending substantially cylindrical configuration extending over a majority of the circumference of said outer surface and a truncated surface interrupting said substantially cylindrical configuration; a cutting element positioned in said truncated surface and spaced from said outer surface; a transverse axis, transverse to the longitudinal axis, the transverse axis intercepting at least a portion of the substantially cylindrical configuration, and intercepting at least a portion of the cutting element; wherein said longitudinally extending substantially cylindrical configuration extends over an arc of at least 240° of the circumference of said outer surface.
 12. The reaming head of claim 11, further including a rounded leading surface adjacent said cylindrical configuration.
 13. The reaming head of claim 11, wherein said longitudinally extending substantially cylindrical configuration is substantially uninterrupted.
 14. The reaming head of claim 11, wherein said longitudinally extending substantially cylindrical configuration consists essentially of a single longitudinally extending substantially cylindrical configuration.
 15. The reaming head of claim 11, wherein said cutting element consists essentially of a single cutting element.
 16. The reaming head of claim 11, further comprising a guide wire lumen.
 17. A reaming head, comprising: a body having a longitudinal axis and a perpendicular axis perpendicular to the longitudinal axis; an outer surface disposed on a first side of the body, a truncated surface disposed on a second side of the body; a cutting element positioned in said truncated surface and spaced from said outer surface; a first end of the perpendicular axis intercepting at least a portion of the outer surface, and a second end of the perpendicular axis intercepting at least a portion of the truncated surface; wherein said cutting element comprises a blade extending in substantial alignment with said longitudinal axis.
 18. The reaming head of claim 17, further including a rounded leading surface adjacent said outer surface.
 19. The reaming head of claim 17, wherein said outer surface extends over an arc of at least a majority of a circumference of said body.
 20. The reaming head of claim 17, wherein said outer surface is substantially uninterrupted.
 21. The reaming head of claim 17, wherein said cutting element consists essentially of a single cutting element.
 22. The reaming head of claim 17, further comprising a guide wire lumen.
 23. A reaming head, comprising: a body having a longitudinal axis and a perpendicular axis perpendicular to the longitudinal axis; an outer surface disposed on a first side of the body, a truncated surface disposed on a second side of the body; a cutting element positioned in said truncated surface and spaced from said outer surface; a first end of the perpendicular axis intercepting at least a portion of the outer surface, and a second end of the perpendicular axis intercepting at least a portion of the truncated surface; wherein said outer surface extends over an arc of at least 240° of a circumference of said body.
 24. The reaming head of claim 23, further including a rounded leading surface adjacent said outer surface.
 25. The reaming head of claim 23, wherein said outer surface extends over an arc of at least a majority of a circumference of said body.
 26. The reaming head of claim 23, wherein said outer surface is substantially uninterrupted.
 27. The reaming head of claim 23, wherein said cutting element consists essentially of a single cutting element.
 28. The reaming head of claim 23, further comprising a guide wire lumen. 